Anterior approach for major right hepatic resection for large hepatocellular carcinoma
Anterior approach for major right hepatic resection for large hepatocellular carcinoma
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DOI：
10.1097/00000658-200007000-00004
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发表时间：
2000-07-01
影响因子：
9
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Liu, CL;Fan, ST;Wong, J
目的比较前路与常规入路在大肝癌右肝切除术中的手术效果和远期疗效。摘要背景资料常规入路右肝大切除对大肝癌有很大的困难，在肿瘤移动过程中强力回缩可能导致严重的并发症，包括癌细胞扩散、医源性肿瘤破裂、大出血等，导致手术和远期预后不良。方法对肝右叶大肝癌行肝大切除的患者，采用前路入路技术，在肝门控制入肝血管后，在不动肝右叶及肿瘤的情况下，从肝前表面至暴露下腔静脉前表面行超声解剖肝实质横断。所有静脉分支，包括右肝静脉，在右肝叶被动员之前被控制。回顾性分析手术和长期结果，并比较采用传统方法进行手术的患者。结果1989 ~ 1997年，54例直径5cm及以上的肝细胞癌采用前路行右肝大切除术，与同期106例临床参数相近的常规入路行肝切除术患者相比，前路组术中出血量和输血量明显减少，住院死亡率低，肺转移发生率低。中位无病生存期和中位总累积生存期也更好。结论与常规入路相比，前路可提高手术成功率和生存率，是大肝癌右肝切除术的首选入路。
Objective To report the surgical and long-term outcomes of major right hepatic resection for large hepatocellular carcinoma (HCC) using the anterior approach compared with the conventional approach.Summary Background Data Great difficulty can be encountered during major right hepatic resection for large HCC using the conventional approach, Forceful retraction during mobilization of the tumor might result in serious complications, including dissemination of cancer cells, iatrogenic tumor rupture, and excessive bleeding, leading to unfavorable surgical and long-term outcomes.Methods In patients who had large HCC at the right lobe of liver and underwent major hepatic resection, the technique of anterior approach was used, After hilar control of the inflow blood vessels and without prior mobilization of the right lobe of liver and the tumor, parenchymal transection was performed using an ultrasonic dissector from the anterior surface of the liver until the anterior surface of the inferior vena cava was exposed. Ail venous tributaries, including the right hepatic vein, were controlled before the right lobe of liver was mobilized. Surgical and long-term outcomes were analyzed retrospectively and compared with patients who underwent surgery using the conventional approach.Results From 1989 to 1997, the anterior approach was used for major right hepatic resection in 54 patients with HCC of 5 cm or more in diameter, When compared with the 106 patients with similar clinical parameters who underwent hepatic resection using the conventional approach during the same period, the patients in the anterior approach group had significantly less intraoperative blood loss and blood transfusion, a lower hospital death rate, a lower incidence of pulmonary metastases, and a better median disease-free survival and median overall cumulative survival.Conclusion The anterior approach is the preferred technique for major right hepatic resection for large HCC because it resulted in improved surgical and survival outcomes compared with the conventional approach.